More on Gender Specificity

More on Gender Specificity

Some diseases are logically gender specific.  Breast cancer for example is primarily female in nature (although of course male cases do exist!).  Diseases related to gender-specific anatomical parts are the most gender specific, such child delivery or a type of infection known as balantidiasis involving the penis.   

Gender differences may also exist for diseases due to their human behavioral component.  This means that the disease is not completely physiological and anatomical nature, but instead has a sociocultural influence playing a very important role in its definition, manifestation and diagnosis.   The following curve depicts a normally distributed disease regarding age and gender and a common form that a female favoring ICD presents with in population health studies.

Gender-specific behaviors complicate this review of gender differences slightly.  The most common reason expected for gender assymmetry related to preventive health care, and results in outcomes for chronic diseases that require considerable amounts of care and case management activities.  Claims related heart disease diagnoses for example tend to show female prevalence great than male prevalence up until the age of 55 years old.  This is possibly due to other care management practices women are engaged in, such as periodic breast and cervical cancer screening, and care for their children.  The opportunity to engage in an office visit by an unemployed mother caring for children may make her age group of women more likely to get adequate care than employed women and men, thereby adding further to an aymmetry in preventive care behaviors that already exist. 

The above right figure represents the distribution of diseases more commonly associated with women than men, including such maladies as Fibromyalgia, GERD, IBS, and regarding the ICD illustrated above, Rheumatoid Arthritis.  The following diseases demosntrate gender induced asymmetry.

[ADD LIST for Female]

[Men]

Behavioral Differences by Gender

[Note: Claims are used to identify patients and produce patient counts.  These counts and their one-year incidence-prevalence numbers pertain to numbers of patients filing a claim with the ICD linked to it, not the number of claims filed.]

Based on patient-claims relationships, the following behavioral Differences between genders may be noted (some noted above, or elsewhere):

  • Women tend to engage in preventive health measures at least 10 years earlier than men (i.e. breast cancer and cervical PAPs)
  • Men outnumber women for certain chronic disease claims, once they reach that age where the two genders equilibrate; this possibly represents higher frequency of palliative care due to lack of preventive visits and belated care for specific chronic disease types (male patients deny need for care longer than women).
  • Men can show two peaks for specific older age diseases whereas women tend to show constant progression and increased frequency, without demonstratring a two-peak effect.  For example, men in the working age show an early diagnosis-treatment period for certain heart diseases, followed by a lull in incidence-prevalence, followed by a second and final peak 15 years later.  Women’s behaviors for this same disease demonstrate a single curve to peak age, followed by mortality-related descent in incidence-prevalence.
  • The more behavioral an ICD is, the more likely there will be a difference between male and female rates for these ICDs.  For example, males represents a peak age of 17-19 for smoking behavior prevalence, females never demonstrate such a strong peak.  As females age however, their peak in smoking is noted for some period between 35 and 50 years of age, and this prevalence is often greater than that for men.  
  • Some ICDs, although theoretically bisexual in nature, are primarily single-gendered in actual reporting and documentation.  Anorexia nervosa for example is 10-25 times more incidential and prevalent in female populats about 17-25 years of age than for men.  The  related bulemia disorder also demonstrates this statistical behavior, but does have a larger number of events documented for men and women between 24 and 55 years of age.
  • Even though a female ICD for impotence exists in ICD9, men far outnumber women for this ICD.
  • Sexually transmitted diseases have very specific gender differences.  Men are mostly related to Syphilis related claims, and women to most or all others.  Sexual-related biological conditions or problems are primarily evaluated clinically for women.
  • Some childhood behaviors demonstrate gender specific differences.   Boys are much more likely than girls to engage in or have documented an aggressive behavior, women are more likely to be related to certain non-physically aggressive behaviors, such as those involving primarily inward (non-social or anti-family/anti-parent) personality and behavioral change. 

Examples

[Figure: Male section of pyramid has peak at 75 yo; second figure has pyramid with narrow age band female peak at 13 yo. Onset of diagnosis noted at about 35-40 yo., withe female diagnoses accidentally included in historical documents for 65+ yo group.]

The gender-specific condition on the left is an occupational disease that relates almost entirely to men.  The condition on the right is a sociocultural behavioral disease or syndrome related mostly to women. 

These two conditions have very different temporal features. 

The first is of old age occurence, and notice it continues past retirement years, and has a reduction in survival rates after the age of 75.  This condition is brought on occupationally by long term occupation related risks, resulting in physical deterioration in the later years.  Examples of this type of problem could include such medical problems relate to long-term radiation exposure in a male dominant job, long-term exposure to a primarily males only carcinogen, or long-term male-specific environmentally induced disease problems, such as physically compromising, high weight related occupational risks.  There is a 20:1 ratio for frequencies of men:women.

The second condition occurs in women and had an age distribution much greater than that of men.  Interestingly, the peak year is 15 or 16, with this large peak reducing in size quickly by the time the early 20s are reached.  There is a 6:1 ratio of women:men.

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